Basketball, baseball, and air guns caused nearly half of trauma during 2010-13

Action Points

About 120,000 individuals presented to emergency departments nationwide between 2010 and 2013 with a diagnosis of sports-related ocular injury, which was the primary diagnosis in almost 86,000 patients.

Note that basketball, baseball, and air guns were the most common causes of injury, accounting for almost half of all primary sports-related eye injuries.

Almost 86,000 patients presented to U.S. emergency departments from 2010 to 2013 with a primary diagnosis of sports-related eye injury, according to a cross-sectional study in JAMA Ophthalmology.

The observed overall injury burden was substantially higher than in previous estimates, reported R. Sterling Haring, DO, MPH, of the University of Lugano in Switzerland and Johns Hopkins University, Baltimore, and colleagues. The majority of injuries affected adolescents, with 60% of injured males and 67% of injured females being age 18 or younger.

Since the study used data from the Nationwide Emergency Department (NED) Survey, the number of injuries may actually be considerably higher since the survey does not include visits to other types of care venues or medically untreated injuries.

Over the study period, 120,847 individuals with a mean age of 22.3 years presented with sports-related ocular trauma – about 3% of all eye trauma – and 81.3% of these injuries occurred in males.

Among males, basketball led the list of causes (25.7%, 95% CI 24.7%-26.7%). It was followed by baseball or softball at 13.2% (95% CI 12.5%-13.8%), and shooting air guns at 12.7% (95% CI 11.7%-13.8%). In females, baseball or softball was the most common cause of injury (19.2%, 95% CI 17.8%-20.7%), followed, interestingly, by cycling at 10.8% (95% CI 9.7%-12.1%) and soccer at 10.3% (95% CI 9.2%-11.5%).

Commenting on the study for MedPage Today, American Academy of Ophthalmology clinical spokesperson Philip R. Rizzuto, MD, of Brown Alpert Medical School in Providence, RI, welcomed its quantification of the magnitude of the problem. "The number of 30,000 for emergency department visits is amazing. It helps us realize just how common and significant these eye injuries are," he said. "But many people with injuries will also visit the physician who cares for their eyes and not the ED, so I agree the number of injuries is probably higher."

The study found presentation to emergency departments peaked at age 17 for boys and 16 for girls and then substantially diminished in both genders.

The prominent role of cycling and soccer in these injuries was especially surprising, as these have not traditionally been considered high-risk activities, noted Haring in a Johns Hopkins news release.

"Thousands of cycling-related eye injuries occur each year. Many of these could probably be prevented by something as simple as wearing wrap-around sunglasses," he said.

Lacerations to the adnexa were the most common injuries, followed by contusions to the eye and adnexa. Although most sports-related injuries were superficial, 20.9% of baseball-related injuries were blowout fractures of the orbit.

Impaired vision was rare but showed a strong affiliation with recreational projectile-firing devices. Paintball and air guns accounted for 991 of all 3,760 cases leading to impaired vision (26.4%), despite accounting for only 11,937 of all 120,847 injuries (9.9%). Relative to football, the chances of impairment with paintball and air gun injuries were substantially greater, with odds ratios of 4.75 (95% CI 2.21-10.19) and 3.71 (95% CI 2.34-5.88, P<0.001). The longer-term consequences of this impairment remain unclear.

"While brain injuries such as concussions are getting a lot of attention these days, everyone from Little League coaches to weekend warriors need to understand that there are real risks to the eye when playing sports," Haring said in the news release. "Now that we recognize what sports may be most hazardous to the eye, we need to look for the best ways to prevent these injuries."

According to Rizzuto, ophthalmologists are already out in the community talking to parents, children, and coaches about aggressive protective measures. "I'm encouraged to see the progress made in eye protection in hockey, and it would be great to see progress in other team sports and in casual activities," he said. "Wearing eye gear would not seem so bad if people were aware it could prevent a devastating injury."

Rizzuto is encouraged by the number of youngsters in his community who now ride bikes with protective goggles, regular glasses, or sunglasses. "As a trauma surgeon treating eye injuries, I think it would be great if I was pushed out of business."

The authors acknowledged the limitations of the NED administrative database, which does not capture those visiting other types of facilities or not seeking medical care. In addition, post-discharge information such as surgical intervention and hospitalization is unavailable in this data set, as are data on long-term visual outcomes or detailed assessments of visual acuity.

"Reducing sports-related ocular trauma among individuals engaging in these activities, along with individual sports with high levels of injuries, such as cycling, will likely require a coordinated approach from policy makers, industry, and public health professionals," the authors wrote. "Further research is warranted to identify opportunities for intervention among sports participants."

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